大脑中动脉粥样硬化狭窄的3.0T HR-MRI和DSA比较研究

Comparison of 3.0T high-resolution MRI and DSA of middle cerebral artery atherosclerotic stenosis

目的:对比分析3.0T HR-MRI和DSA对疾病患者的大脑中动脉M1段(即水平段)狭窄程度的诊断符合情况,探讨3.0T HR-MRI评价大脑中动脉狭窄程度的临床价值。方法:67例大脑中动脉狭窄患者均行3.0T HR-MRI和DSA检查,并以DSA为金标准计算HR-MRI诊断大脑中动脉狭窄程度的敏感性、特异性、准确性以及阳性预测值、阴性预测值,分析3.0T HR-MRI诊断大脑中动脉狭窄程度与DSA的符合情况。结果:67例病人共134段目标血管,HR-MRI与DSA诊断相符合共124段,符合率92.5%,HR-MRI诊断大脑中动脉轻、中、重度狭窄及闭塞的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为80%、99.2%、98.5%、80%、99.2%,95.7%、98.5%、91.4%、84.6%、98.5%,84%、98.2%、91.4%、80.8%、95.7%,100%、100%、100%、100%、100%。Youden指数分别为79.2%、94.2%、82.2%、100%,Kappa值分别为0.792、0.788、0.895、1。结论:3.0T HR-MRI在评价大脑中动脉狭窄程度方面具有很高的敏感性、特异性和准确性,与DSA诊断有很好的相关性,结合管壁成像,可作为大脑中动脉粥样硬化狭窄筛查的一种常规检查方法。

Objective： To compare 3.0T HR-MRI and DSA for the diagnosis of the middle cerebral artery M1 segment stenosis and discuss the clinical value and limitation of 3.0T HR-MRI in the diagnosis of middle cerebral artery atherosclerot- ic stenosis. Methods： Sixty-seven patients with ischemic cerebrovascular disease received both 3.0T HR-MRI and DSA exam- inatin. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of 3.0T HR-MRI diagnosis of middle cerebral artery stenosis were calculated using DSA as the golden standard. The clinical value of 3.0T HR-MRI di- agnosis of intracranial vascular stenosis was evaluated. Results： Among 67 patients, 124 blood vessels showed the same condi- tion as DSA, with the coincidence rate of 92.5%. The sensitivity, specificity, accuracy, positive predictive value, negative pre- dictive value in 3.0T HR-MRI diagnosis of mild degree, moderate degree, severe degree stenosis and obliteration were 80%, 99.2%, 98.5%, 80%, 99.2%; 95.7%, 98.5%, 91.4%, 84.6%, 98.5%; 84%, 98.2%, 91.4%, 80.8%, 95.7%; 100%, 100%, 100%, 100%, 100%. For mild, moderate, severe degree stenosis, and occlusion of MCA rates according to Youden index were 79.2%, 94.2%, 82.2%, 100%; Kappa values were 0.792, 0.788, 0.895, 1. Conclusions： 3.0T HR-MRI evaluation of middle cerebral artery atherosclerotic stenosis has a high sensitivity, specificity and accuracy, with a good relevance with DSA. 3.0T HR-MRI can replace DSA to become a general choice for cerebrovascular stenosis screening examination.